NBME 21

Block 1/Question#1
A 24-year-old woman with sickle cell disease comes to the ...
Serum parvovirus B19 IgM antibody test

Block 1/Question#2
A 6-month-old girl is brought to the physician because her ...
GM2

Block 1/Question#3
An investigator is studying the efficacy of distinct vaccine ...
Flagellin

Block 1/Question#4
A 67-year-old man comes to the emergency department because ...
Translation

Block 1/Question#5
A 45-year-old woman is brought to the emergency department 45 ...
Absorption atelectasis

Block 1/Question#6
A normal-appearing 17-year-old girl has never had a menstrual ...
Androgen insensitivity syndrome

Block 1/Question#7
A 30-year-old primigravid woman at 22 weeks' gestation comes ...
Listeria monocytogenes

Block 1/Question#8
A 52-year-old woman is admitted to the hospital because of ...
Speak with the two gynecologists to attempt to coordinate care

Block 1/Question#9
A 53-year-old woman who underwent an operation for breast ...
Breast: antagonist; Uterus: partial agonist

Block 1/Question#10
A 34-year-old woman is brought to the emergency department 30 ...
Primary metabolic acidosis with increased anion gap

Block 1/Question#11
A 27-year-old primigravid woman at 34 weeks' gestation is ...
Schistocytes

Block 1/Question#12
A 25-year-old nulligravid woman comes to the physician ...
Endometrial hyperplasia

Block 1/Question#13
A 25-year-old man develops shortness of breath after moving ...
Decreased alveolar Po2

Block 1/Question#14
A 21-year-old man is brought to the emergency department 45 ...
Streptococcus pneumoniae

Block 1/Question#15
A 35-year-old man comes to the physician because of a 1-day ...
Increased vascular permeability

Block 1/Question#16
A 43-year-old man comes to the physician for a follow-up ...
Aortic

Block 1/Question#17
A 7-year-old girl is brought to a clinic in a developing ...
Methionine

Block 1/Question#18
A 61-year-old woman is brought to the physician by her ...
Donepezil

Block 1/Question#19
A 22-year-old man has had frequent episodes of cutaneous ...
C1 esterase inhibitor (binds activated C1r, C1s)

Block 1/Question#20
A 10-year-old girl develops fever, malaise, and loss of ...
Retrograde transport through nerves

Block 1/Question#21
A 40-year-old man with type 2 diabetes mellitus comes to the ...
Stimulation of the peroxisome proliferator-activated receptor γ

Block 1/Question#22
A 36-year-old man with AIDS elects to participate in a ...
Chemokine

Block 1/Question#23
A 59-year-old man comes to the physician because of a 3-month ...
Foci of keratinization

Block 1/Question#24
A 23-year-old man drinks alcohol heavily on a weekend. Which ...
Fatty change

Block 1/Question#25
A 28-year-old man is brought to the emergency department 30 ...
Dissecting aneurysm

Block 1/Question#26
A 62-year-old man who is a farmer comes to the physician ...
Actinic keratosis

Block 1/Question#27
A 60-year-old man is brought to the emergency department ...
Urethral disruption

Block 1/Question#28
A 47-year-old man is brought to the emergency department by ...
Mixed venous oxygen tension

Block 1/Question#29
A 34-year-old man comes to the physician because of a 2-week ...
Cluster headache

Block 1/Question#30
A newborn has female external genitalia and a 46,XY ...
Dihydrotestosterone

Block 1/Question#31
A 30-year-old woman comes to the office for a follow-up ...
Linoleic acid

Block 1/Question#32
A 50-year-old man has had progressive dyspnea on exertion ...
Usual interstitial pneumonitis

Block 1/Question#33
A 30-year-old man comes to the physician because of a ...
Varicella-zoster virus infection

Block 1/Question#34
A 30-year-old man develops urinary incontinence 2 weeks after ...
Pelvic nerves

Block 1/Question#35
A 7-year-old boy is brought to the physician by his mother ...
Increased blood lead

Block 1/Question#36
A 51-year-old woman comes to the physician because of a ...
Area labeled 'B' (Parietal cell)

Block 1/Question#37
A 35-year-old man with diabetic ketoacidosis has a decrease ...
Serum potassium concentration

Block 1/Question#38
A 47-year-old woman with aplastic anemia is being treated for ...
Amphotericin B

Block 1/Question#39
A 33-year-old woman comes to the physician because of fever, ...
Genital herpes

Block 1/Question#40
A physician prescribes a recently marketed drug for 20 ...
Phase 4

Block 1/Question#41
A 35-year-old woman comes to the physician because of a 2-day ...
Uroporphyrinogen decarboxylase

Block 1/Question#42
A 36-year-old woman undergoes a total hysterectomy and ...
Hyperplasia

Block 1/Question#43
A 52-year-old man is brought to the emergency department 30 ...
Histamine

Block 1/Question#44
A test has been developed to screen for human papillomavirus ...
Predictive value of a positive test

Block 1/Question#45
An 18-year-old man comes to the physician because of a 2-week ...
Pyruvate kinase

Block 1/Question#46
A 66-year-old man is brought to the emergency department ...
Lipopolysaccharide stimulation of toll-like receptor

Block 1/Question#47
A 26-year-old woman (III-2) comes to the physician for ...
50% in females but near 0 in males

Block 1/Question#48
A 44-year-old man is admitted to the hospital because of ...
Increasing cGMP

Block 1/Question#49
An 80-year-old woman comes to the emergency department ...
Hydrochlorothiazide

Block 1/Question#50
A photograph is shown of a myelin-stained cross section of a ...
Loss of sensation to vibration over both feet

Block 2/Question#1
A 27-year-old man comes to the physician for an examination ...
Schizoid

Block 2/Question#2
A 4-year-old girl is conscious but unable to breathe ...
Pseudocholinesterase deficiency

Block 2/Question#3
A 17-year-old boy returns to the locker room after football ...
Apocrine

Block 2/Question#4
An 18-year-old woman comes to the office because of a 2-week ...
Extensor carpi radialis brevis

Block 2/Question#5
A 2-week-old male newborn has a patent ductus arteriosus. ...
Higher than normal left ventricular cardiac output

Block 2/Question#6
A 38-year-old woman comes to the physician because of a ...
Serum calcium concentration

Block 2/Question#7
A 50-year-old man with rheumatoid arthritis comes to the ...
Anemia of chronic disease

Block 2/Question#8
A 55-year-old man is diagnosed with renal artery stenosis. ...
Cortex

Block 2/Question#9
A 40-year-old man is brought to the emergency department 45 ...
Metabolic acidosis and respiratory acidosis

Block 2/Question#10
A 42-year-old woman comes to the physician because of a ...
Rosacea

Block 2/Question#11
A 22-year-old woman, gravida 1, para 1, is brought to the ...
Internal iliac

Block 2/Question#12
A 66-year-old woman comes to the physician because of fever, ...
Diverticulitis

Block 2/Question#13
A 53-year-old woman with gastroesophageal reflux disease ...
Omeprazole

Block 2/Question#14
A 30-year-old woman comes to the office because she is ...
Abnormal brain development

Block 2/Question#15
A 48-year-old man is brought to the emergency department ...
Splenic and left renal

Block 2/Question#16
A 34-year-old woman comes to the physician because of a ...
Atrioventricular bundle

Block 2/Question#17
Scientists have identified the flawed gene that causes about ...
Mismatch repair

Block 2/Question#18
A 34-year-old woman comes to the physician because she has ...
“I’m concerned about how bad you’ve been feeling lately. Have you had any thoughts about death or wanting to be dead?”

Block 2/Question#19
A 3-year-old boy who recently immigrated to the USA is ...
Increased proportions of osteoid

Block 2/Question#20
A 14-year-old girl is brought to the physician by her mother ...
Trichotillomania

Block 2/Question#21
A 35-year-old woman undergoes flexible nasopharyngoscopy ...
Superior to the superior concha

Block 2/Question#22
A 33-year-old woman, gravida 4, para 4, is admitted to the ...
Transfusion-related acute lung injury

Block 2/Question#23
A 4-year-old boy with chronic granulomatous disease is ...
Macrophages producing interleukin-1 (IL-1)

Block 2/Question#24
A 65-year-old man dies in a motor vehicle collision. A ...
Squamous cell carcinoma

Block 2/Question#25
A 54-year-old man comes to the physician for a routine health ...
Area labeled 'F' (Efferent arteriole)

Block 2/Question#26
A healthy 32-year-old woman at 35 weeks' gestation is ...
Birth canal reflex

Block 2/Question#27
A 47-year-old woman with psoriasis comes to the physician for ...
“Most people find it difficult to stick to a routine. How did you do?”

Block 2/Question#28
A 64-year-old woman with type 2 diabetes mellitus and ...
Gemfibrozil

Block 2/Question#29
A healthy 25-year-old man is participating in a study of ...
Alanine

Block 2/Question#30
A 44-year-old man comes to the physician because of ...
Leukotriene C4: increased;
Arachidonic acid: increased;
Prostaglandin H2: decreased;
Prostaglandin E2: decreased


Block 2/Question#31
A 37-year-old man is brought to the emergency department 45 ...
Intercostal

Block 2/Question#32
A 17-year-old boy has the acute onset of lethargy, sore ...
Lymphocytes

Block 2/Question#33
A 68-year-old man comes to the physician because of a 1-month ...
Libido: normal; Nocturnal erections: normal

Block 2/Question#34
A 28-year-old man is brought to the emergency department ...
Inferior rectus and inferior oblique

Block 2/Question#35
A 4-month-old female infant is brought to the emergency ...
Hyponatremia

Block 2/Question#36
An investigator is conducting a study of antiretroviral ...
Enfuvirtide

Block 2/Question#37
A 17-year-old boy is evaluated for constitutional delay in ...
Craniopharyngioma

Block 2/Question#38
A 63-year-old man with bladder cancer starts treatment with ...
Tubulin polymerization stabilization

Block 2/Question#39
A 64-year-old man with bronchospastic pulmonary disease ...
Enhanced action of the agonist at β-adrenergic receptors

Block 2/Question#40
Acetaminophen and nonsteroidal antiinflammatory agents reduce ...
Prostaglandin E2

Block 2/Question#41
A 75-year-old woman has the sudden onset of Horner syndrome ...
Posterior inferior cerebellar

Block 2/Question#42
A 26-year-old man with HIV infection comes to the physician ...
Penicillin

Block 2/Question#43
A 78-year-old woman is brought to the emergency department by ...
Embolectomy

Block 2/Question#44
A 75-year-old man has the sudden onset of partial loss of ...
Parietal lobe, left

Block 2/Question#45
A 3-year-old boy is brought to the emergency department ...
Synthesis of factor X (Stuart factor)

Block 2/Question#46
An 8-year-old girl is brought to the physician for a ...
“Your daughter’s development is normal.”

Block 2/Question#47
A 55-year-old woman comes to the physician because of a ...
Increased parathyroid hormone

Block 2/Question#48
A 75-year-old man has fever, back pain, and pain on ...
Enterococcus faecalis

Block 2/Question#49
A 6-year-old girl is brought to the physician by her mother ...
Poxvirus

Block 2/Question#50
A 65-year-old woman comes to the emergency department because ...
Lung and common carotid artery

Block 3/Question#1
A 30-year-old woman develops dimness of vision
Ethambutol

Block 3/Question#2
A 40-year-old man with interstitial pulmonary fibrosis has a ...
Increased radial traction on airways

Block 3/Question#3
A 55-year-old African American man with hypertension is asked ...
Tell the patient that he can change his mind about participating

Block 3/Question#4
A clinical trial is conducted to compare the efficacy of a ...
Surgical procedure group: 400; Medical management group: 400

Block 3/Question#5
A 70-year-old woman is found to have persistent fever despite ...
Candida albicans

Block 3/Question#6
A 40-year-old African American woman comes to the physician ...
1,25-Dihydroxycholecalciferol

Block 3/Question#7
A 65-year-old man comes to the physician because of a 1-month ...
DNA fragmentation

Block 3/Question#8
A 55-year-old woman is brought to the emergency department by ...
Mammillary bodies

Block 3/Question#9
A 75-year-old woman is brought to the emergency department ...
Shrunken eosinophilic (red) neurons

Block 3/Question#10
A 30-year-old man has had intermittent severe lower abdominal ...
Cysteine

Block 3/Question#11
A 50-year-old man is found dead in bed at home. His family ...
Arrhythmia

Block 3/Question#12
A 55-year-old man with hypertension comes to the physician ...
Left renal artery atherosclerosis

Block 3/Question#13
A 40-year-old woman comes to the physician for an initial ...
Antagonizes VLDL-cholesterol secretion

Block 3/Question#14
A 35-year-old man is brought to the emergency department ...
Activation of adenylyl cyclase

Block 3/Question#15
A 47-year-old man has jaundice. Laboratory findings include ...
Obstruction of the bile duct

Block 3/Question#16
A 16-year-old boy is brought to the physician because of a ...
Exercise-induced asthma

Block 3/Question#17
A 66-year-old woman with pancreatic cancer comes to the ...
Short gastric

Block 3/Question#18
An 83-year-old man comes to the physician because of a 3-day ...
Bullous pemphigoid antigen

Block 3/Question#19
A 25-year-old woman develops increasing shortness of breath ...
Four-chamber dilation

Block 3/Question#20
A 68-year-old woman has had a fever and shortness of breath ...
Reactive granulocytosis

Block 3/Question#21
A screening program is instituted for detection of vaginal ...
10%

Block 3/Question#22
A 9-year-old boy has mild mental retardation and a 4-year ...
Rhabdomyoma

Block 3/Question#23
A 43-year-old woman dies after a 10-year illness ...
Area labeled ‘C’ (Caudate nucleus)

Block 3/Question#24
Diastolic blood pressures are obtained in two groups of 100 ...
Median of group Y: higher; Mode of group Y: higher

Block 3/Question#25
A 32-year-old woman comes to the physician because her sister ...
Dysplastic nevi

Block 3/Question#26
A 19-year-old woman comes to the office because of a 1-month ...
Descending colon

Block 3/Question#27
A 55-year-old woman with a benign nodule in the left lobe of ...
External carotid

Block 3/Question#28
A 1-year-old girl is admitted to the hospital because of a ...
Disruption of the secondary structure of collagen molecules

Block 3/Question#29
A 34-year-old man is evaluated after becoming light-headed ...
Number of impulses from carotid baroreceptor: decreased;
Sympathetic efferent activity: increased;
Parasympathetic efferent activity: decreased


Block 3/Question#30
A 41-year-old man comes to the physician because of a 6-week ...
Abduction of the upper extremity

Block 3/Question#31
A 28-year-old woman at 18 weeks' gestation has palpitations. ...
Free T4

Block 3/Question#32
A 72-year-old man comes to the physician because of a 2-week ...
Bleomycin

Block 3/Question#33
Left radial arterial and venous blood samples are drawn from ...
HCO3 transported in the plasma

Block 3/Question#34
A 39-year-old woman with rheumatoid arthritis develops ...
Membranous glomerulonephritis

Block 3/Question#35
A 63-year-old woman comes to the physician because of a 5-day ...
Increased resting cardiac output

Block 3/Question#36
Which of the following best explains why the use of an ...
Myeloma cells do not have membrane-bound surface immunoglobulin

Block 3/Question#37
A 5-year-old boy who has homocystinuria improves with ...
The line on the graph labeled ‘B’

Block 3/Question#38
A 28-year-old man develops a temperature of 39.9°C (103.8°F) ...
Granulocyte colony-stimulating factor

Block 3/Question#39
A 74-year-old woman with mild dementia is admitted to the ...
Inability to understand the severity and prognosis of her medical condition

Block 3/Question#40
A 65-year-old woman undergoes surgical repair of an aneurysm ...
Area labeled ‘A’ (Cranial nerve 3)

Block 3/Question#41
A 75-year-old woman comes to the physician's office because ...
Major depressive disorder

Block 3/Question#42
A 27-year-old primigravid woman at 39 weeks' gestation is ...
Shoulder dystocia

Block 3/Question#43
An undernourished 70-year-old man has fever, night sweats, ...
Interferon-γ

Block 3/Question#44
A 23-year-old woman develops persistent sneezing each year in ...
Stabilization of mast cell membranes

Block 3/Question#45
A 28-year-old man comes to the physician for evaluation of ...
Fructose

Block 3/Question#46
A 38-year-old woman comes to the physician because of a ...
Patent foramen ovale

Block 3/Question#47
A 48-year-old man comes to the physician because of ...
Increased intestinal iron absorption

Block 3/Question#48
A 29-year-old woman comes to the physician because of a ...
Baclofen

Block 3/Question#49
The gene that codes for a protein normally found in the ...
Deletion of a hydrophobic amino acid sequence from the N terminus

Block 3/Question#50
A 32-year-old woman comes to the emergency department because ...
Arthropod vector

Block 4/Question#1
A 50-year-old woman has azotemia. Renal ultrasonography shows ...
Uterine cervix

Block 4/Question#2
A 23-year-old woman comes to the student health center ...
Obliterative endarteritis with lymphocytes and plasma cells

Block 4/Question#3
A study was performed that evaluated the relationship between ...
Odds ratio

Block 4/Question#4
The FOXO transcription factor responds to insulin signaling ...
Nuclear/cytoplasmic shuttling: yes;
Serine phosphorylation: yes
Ubiquitin-mediated proteolysis: no


Block 4/Question#5
An 11-year-old boy has had persistent pain in his right knee ...
Lung

Block 4/Question#6
A 55-year-old man comes to the physician because of a 2-month ...
Cortisol

Block 4/Question#7
A 14-year-old boy is brought to the physician by his mother ...
Inhaled glue

Block 4/Question#8
A 70-year-old woman has had recurrent pneumonia, fatigue, and ...
Euthyroid sick syndrome

Block 4/Question#9
A 60-year-old woman with psoriasis comes to the physician ...
Porphyria cutanea tarda

Block 4/Question#10
A 64-year-old man is evaluated for cough, dyspnea, and chest ...
Hyponatremia

Block 4/Question#11
A study is conducted on patients with asthma to compare a new ...
If the treatment really changes the mean asthma score by 0.4, there is an 80% chance that a study of this size will find a p-value < 0.05

Block 4/Question#12
A 24-year-old man with a history of drug abuse has nausea, ...
Heroin

Block 4/Question#13
A 4-month-old boy is diagnosed with a rare autosomal ...
Dilated rough endoplasmic reticulum

Block 4/Question#14
A 25-year-old woman has a 3-week history of bleeding gums ...
Autoantibodies against platelet glycoproteins

Block 4/Question#15
A 5-year-old boy is brought to the physician for a well-child ...
Lack of choroidal pigment deposition in the macula

Block 4/Question#16
A 40-year-old woman who had pneumonia due to Streptococcus ...
Surfactant

Block 4/Question#17
A 48-year old man is referred for evaluation of possible ...
Increase in width

Block 4/Question#18
A previously healthy 4-week-old male newborn is brought to ...
Pyloric stenosis

Block 4/Question#19
A 45-year-old woman comes to the emergency department because ...
Hepatopancreatic ampulla

Block 4/Question#20
A 7-month-old boy is brought to the physician 2 days after ...
46,XY

Block 4/Question#21
A 47-year-old man is treated with colchicine for acute gouty ...
Tubulin polymerization

Block 4/Question#22
A 57-year-old woman is brought to the emergency department ...
Ninth

Block 4/Question#23
An investigator is studying the regulation of pulmonary ...
Intravenous infusion of 0.9% saline for 5 minutes

Block 4/Question#24
A 56-year-old man undergoes a renal transplant. Five minutes ...
IgG plus complement

Block 4/Question#25
An 80-year-old woman cannot concentrate her urine above 450 ...
2.0

Block 4/Question#26
The immunosuppressive agent cyclosporin A (CsA) is a potent ...
Interleukin-2 (IL-2) gene transcription

Block 4/Question#27
A 65-year-old woman is being treated in the hospital for ...
“The two of you seem to have a very important relationship. Of course you may stay together.”

Block 4/Question#28
A 56-year-old man undergoes surgical resection of the ...
Release of cholecystokinin

Block 4/Question#29
A 22-year-old man comes to the physician because of a 2-month ...
Formation of destructive free radicals

Block 4/Question#30
A 5-year-old boy is admitted to the hospital because of ...
ApoC-II

Block 4/Question#31
A 48-year-old woman comes to the physician because of a ...
Paracrine stimulation of osteoclasts by osteoblasts

Block 4/Question#32
A 19-year-old college student says he hears voices." He was ...
Risperidone

Block 4/Question#33
A female newborn delivered at 26 weeks' gestation is found to ...
Retina

Block 4/Question#34
A healthy 8-year-old boy is brought to the physician by his ...
Stimulation of the release of biogenic amine neurotransmitters

Block 4/Question#35
A 50-year-old woman is admitted to the hospital because of a ...
Didanosine (ddI)

Block 4/Question#36
A 45-year-old man comes to the physician because of ...
Chondrosarcoma

Block 4/Question#37
A 66-year-old right-handed woman develops the acute onset of ...
Area labeled 'B' (Internal capsule)

Block 4/Question#38
A 62-year-old woman is brought to the physician by her ...
Instruct the patient to keep notes and lists to help her memory

Block 4/Question#39
A 46-year-old man comes to the physician because of a 2-month ...
1/15

Block 4/Question#40
A study is conducted to assess the normal mean serum urea ...
500 Men from a list of patients scheduled to be examined by a urologist

Block 4/Question#41
A 66-year-old man with stage IV colon cancer comes to the ...
Loperamide

Block 4/Question#42
A 20-year-old primigravid woman at 12 weeks' gestation comes ...
Multifactorial

Block 4/Question#43
A 4-year-old boy falls and lacerates his lower leg to the ...
Formation of fibrin clot

Block 4/Question#44
A 28-year-old woman with chronic renal failure (creatinine ...
Furosemide

Block 4/Question#45
During an experiment, an investigator observes that glutamate ...
NMDA receptors are blocked by Mg2+ at the resting membrane potential

Block 4/Question#46
A 14-year-old girl is brought to the physician for a ...
TP53

Block 4/Question#47
While lifting weights, a 24-year-old man develops a painful ...
Strangulation

Block 4/Question#48
A 75-year-old man with dementia, Alzheimer type, is brought ...
Encourage the family to come to a consensus based on their perception of the patient's wishes

Block 4/Question#49
A 76-year-old man comes to the physician because of a 2-week ...
Left thalamus

Block 4/Question#50
A 19-year-old woman is brought to the emergency department 30 ...
Scaphoid

Recent comments ...

... jo made a comment on nbme21/block1/q#1 (A 24-year-old woman with sickle cell disease comes...)
 +1  upvote downvote
submitted by jo(2)

Parvo infects RBC precursors in the marrow which can cause aplastic crisis in sickle cell patients.

jo  Infection of precursors halt RBC maturation which leads to giant pronormoblasts with intranuclear viral inclusions in the periphery (UWorld)
... mcl made a comment on nbme21/block1/q#2 (A 6-month-old girl is brought to the physician...)
 +1  upvote downvote
submitted by mcl(71)

Patient most likely has Tay-Sachs disease. This figure nicely shows the biochemical pathway. Recall that both Tay-Sachs and Neimann Pick disease present with a cherry red spot on fundoscopy, but Tay Sachs lacks the hepatosplenomegaly seen in NP.

hungrybox  Man this is such a nice figure except it doesn't have Krabbe disease :(
mcl  Here's another one with Krabbe! :) https://epomedicine.com/wp-content/uploads/2017/01/lysosomal-storage-diseases-enzyme-defects.jpg
hungrybox  thank u
... usmleuser007 made a comment on nbme21/block1/q#2 (A 6-month-old girl is brought to the physician...)
 +0  upvote downvote
submitted by usmleuser007(17)

1) Very important to note that Tay-Sachs disease has more sensitive startle (moro) reflex in neonates with increased head circumference.

2) Fabry disease = tend to have audio-visual defects w/o liver involvement

3) Niemann-pick disease = anemia & hypotonia with areflexia

... seagull made a comment on nbme21/block1/q#2 (A 6-month-old girl is brought to the physician...)
 +3  upvote downvote
submitted by seagull(158)

! I hate these with a burning F***ing passion. Thumbs up if you agree

mcl  Amen brother
praderwilli  Every morning: "I think i'll go over glycogen storage diseases, lysosomal storage diseases, and dyslipidemias after questions this afternoon." Every afternoon: Nah
mcl  oh my god are you me
praderwilli  I recently found a program called Pixorize. It's pretty much Sketchy for biochem. Wish I discovered it sooner cuz it has helped for a lot of the painful things like this!
... cantaloupe5 made a comment on nbme21/block1/q#3 (An investigator is studying the efficacy of distinct...)
 +5  upvote downvote
submitted by cantaloupe5(24)

Capsular polysaccharide vaccines are often conjugated to proteins to improve immunogenicity. Flagellin is the only answer choice that's a protein.

... wasabilateral made a comment on nbme21/block1/q#3 (An investigator is studying the efficacy of distinct...)
 +3  upvote downvote
submitted by wasabilateral(8)

I think they want you to think about how conjugate vaccine is made: polysaccharide + protein fragment (to induce T dependent immune response). Only flagellin is a protein (or at least sounds like one) in the option list.

vi_capsule  Flagellum is protein. Pilli/Fimbriae - GLycoprotein
... haliburton made a comment on nbme21/block1/q#4 (A 67-year-old man comes to the emergency department...)
 +1  upvote downvote
submitted by haliburton(26)

EF2 is translational elogation factor 2, which is necessary for protein synthesis.

sympathetikey  I. Am. So. DUMB.
nala_ula  same :(
... haliburton made a comment on nbme21/block1/q#5 (A 45-year-old woman is brought to the emergency...)
 +0  upvote downvote
submitted by haliburton(26)

wikipedia (apologies): The atmosphere is composed of 78% nitrogen and 21% oxygen. Since oxygen is exchanged at the alveoli-capillary membrane, nitrogen is a major component for the alveoli's state of inflation. If a large volume of nitrogen in the lungs is replaced with oxygen, the oxygen may subsequently be absorbed into the blood, reducing the volume of the alveoli, resulting in a form of alveolar collapse known as absorption atelectasis.

I chose cardiogenic edema, but I believe this is incorrect because there is no heart failure risk at this time, so the purpose of the PEEP is certainly not to push out fluid.

... nosancuck made a comment on nbme21/block1/q#5 (A 45-year-old woman is brought to the emergency...)
 +10  upvote downvote
submitted by nosancuck(15)

Bruh let me tell you a lil secret

PEEP prevents Atelectasis AKA dat LUNG COLLAPSE

Dont be worryin about random words they puts in front of the HIGH YIELD ones

hungrybox  literally LOL'd lmao I love this
... nosancuck made a comment on nbme21/block1/q#6 (A normal-appearing 17-year-old girl has never had a...)
 -6  upvote downvote
submitted by nosancuck(15)

Yo dis B got NO INTERNAL FEMALE ORGANS

Why dat!???

We be lookin at someone with an SRY from dere Y chromie! Dey be a Y chromie Homie so they be makin some Testis Determinin Factor which I be sure makes some nice lil ANTI MULLERIAN FACTOR so dey aint got that Female Internal Tract u know what i be sayin

And since wimminz is da DEFAULT they stil be gettin dose pussy lips and breastes

meningitis  The above explanation is correct (disregarding the hard to read and unprofessional dialect) but just in case anyone was wondering: chromatin-negative= Just a quick way of knowing it was a boy. The term applies to the nuclei of cells in normal males as well as those in individuals with certain chromosomal abnormalities
yotsubato  Turner syndrome patients are also chromatin negative as well though....
sympathetikey  I didn't know a complication post-meningitis was lack of humor.
sympathetikey  Ah, didn't read the last line. Yeah, that is taking it a bit far
... nerdy nik made a comment on nbme21/block1/q#6 (A normal-appearing 17-year-old girl has never had a...)
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Turner syndrome-> The girl would have a uterus and streak ovaries.

... g.liller@yahoo.com made a comment on nbme21/block1/q#7 (A 30-year-old primigravid woman at 22 weeks'...)
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gram +, B hemolytic, tumbling motility, form rocket tails from actin polymerization which allow for movement, intracellular, grows in cold temps on milk, soft cheeses, ice cream, lunch meat.

increased incidence in pregnant women especially in 3rd trimester

... taway made a comment on nbme21/block1/q#8 (A 52-year-old woman is admitted to the hospital...)
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Does anybody understand why we are allowed to interfere with the clinical decisionmaking of two other specialists directly? Wouldn't that muddy the waters even more by adding our opinion? I don't see the underlying principle that explains the rationale in this answer.

jcrll  I think it's about adding our opinion and more about seeing what the situation is because a patient contacted you in distress. The others are about contacting management off hearsay; that could also "muddy the waters," I Is this question also addressing quaternary prevention?
meningitis  I agree with jcrll. My same thought process but then I changed it to psychiatric consultation in order to first attend the patient's distress and anxiety since it was hindering her decision making. Besides, the whole ordeal about her treatments and ineffectiveness was emotionally and physically exhausting her.
vi_capsule  Referral is NEVER a answer
tsl19  Going straight to the chair of the ethics committee without having spoken to the other physicians would be inappropriate because it would be jumping a bunch of steps in communication first - like jcrll said, you want to get the picture of what's going on from the other physicians first. Maybe the gynecologic oncologist isn't actually as opposed to palliative measures as the patient perceives him to be and thinks he's doing what the patient wants, etc. It could just be miscommunication, which you could help clear up without getting ethics involved ... better to start there.
... hayayah made a comment on nbme21/block1/q#11 (A 27-year-old primigravid woman at 34 weeks'...)
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HELLP syndrome: Hemolysis Elevated Liver enzymes Low Platelets.

A manifestation of severe preeclampsia. Blood smear shows schistocytes. Can lead to DIC and hepatic subcapsular hematomas Ž rupture Ž severe hypotension.

... mcl made a comment on nbme21/block1/q#12 (A 25-year-old nulligravid woman comes to the...)
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submitted by mcl(71)

PCOS is associated with abnormal production of sex steroids, including dysfunction of estrogen production and progesterone. Chronically elevated levels of estrogen can cause endometrial hyperplasia.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3917599/

meningitis  Why isnt it endometriosis? Could someone help me out on this?
meningitis  Sorry, I was confusing with higher risk for endometrial carcinoma.
vi_capsule  Estrogen is responsible for cyclical bleeding and pain associated with endometriosis hence progestin is a treatment modality. But estrogen isnt a risk factor for Endometriosis. Rather theres retrograde flow, metaplatic transformation etc theories are responsible for endometriosis.
sympathetikey  Tfw you get so thrown off by a picture that you don't read the question properly.
... haliburton made a comment on nbme21/block1/q#13 (A 25-year-old man develops shortness of breath after...)
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FA 2017: Chronic hypoxic pulmonary vasoconstriction results in pulmonary hypertension and RVH.

yotsubato  Yeah but in a chronic case this guy would produce more RBC and not be hypoxic anymore.
... aesalmon made a comment on nbme21/block1/q#14 (A 21-year-old man is brought to the emergency...)
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Splenectomy = more susceptible to encapsulated organisms

I put E. coli as its encapsulated but that wasn't the most right answer I guess?

pippylongstock  This question is asking about the ‘S’ of FA Mnemonic for S. Pneumonia “MOPS”. Strep pneumo is the most common cause of sepsis in adults.
... sweetmed made a comment on nbme21/block1/q#15 (A 35-year-old man comes to the physician because of...)
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The chemotactic factors produced by monocytes and mast cells and the local vasodilatation stimulates neutrophilic chemotaxis. Also, endothelial cells activation further aggravates the inflammatory response and migration of neutrophils. This leads to an influx of neutrophils locally.

refrence: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5512152/

... neonem made a comment on nbme21/block1/q#15 (A 35-year-old man comes to the physician because of...)
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submitted by neonem(94)

This is a case of acute gout. Monosodium urate crystals are taken up by neutrophils, leading to an acute inflammatory reaction. T-cells aren't really involved in gout (more rheumatoid arthritis).

hungrybox  Great explanation! So frustrating that I got this wrong, should have been easy.
... mcl made a comment on nbme21/block1/q#16 (A 43-year-old man comes to the physician for a...)
... usmleuser007 made a comment on nbme21/block1/q#17 (A 7-year-old girl is brought to a clinic in a...)
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If you couldn't remember which were essential; then alternative would have been to realize that growing children need cells to divide. This requires DNA replication and translation. Of which the nucleic acid thyime is important. It requires a methyl transfer.

This is where methionine comes in. Methionine combines with ATP to form SAM (a methyl donor)

... mcl made a comment on nbme21/block1/q#17 (A 7-year-old girl is brought to a clinic in a...)
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Methionine is an essential amino acid. All others listed are not.

scalpelofthenorth  Pg 81 Tyrosine is listed as an essential AA. Should be tryptophan for those who got this wrong like me.
neonem  But tyrosine can come from phenylalanine, so it's not really essential right?
gh889  in FA2019, it is listed as Tryptophan, not Tyrosine. That was corrected.
usmleuser007  Note: Tyrosine is ONLY essential with PKU in children
... nosancuck made a comment on nbme21/block1/q#17 (A 7-year-old girl is brought to a clinic in a...)
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Yo dawg we all about PVT TIM HaLL

Phenylalanine, Valine, TryptoDANK, Threonine, Isoleucine, Methionine, Histidine, Leucine Lysine

meningitis  I don't understand what the question is asking... can someone please explain it to me? Patient doesnt eat protein, shes chubby. What does methionine have to do with this?
charcot_bouchard  Just basically asking which is essential amino acids.
usmleuser007  Essential amino acids (something i came up with) 1. "Three HAL fans will try meth" a. Threonine = Three b. Histidine; Arginine; Lysine = HAL c. Phenylalanine = fans d. Valine; Isoleucine; Leucine = will e. Tryptophan = try f. Methionine = meth
nala_ula  They're saying there is a lack of good quality protein -> slight nutritional deficiency. She may have acquired weight but it's not because of protein. So they're specifically asking what amino acid she might be missing due to her subpar diet. Since essential amino acids are those that the body cannot make itself, out off those listed, methionine is the essential amino acid. It's on page 81 of FA 2019.
nala_ula  correct me if I'm wrong please :)
... usmleuser007 made a comment on nbme21/block1/q#17 (A 7-year-old girl is brought to a clinic in a...)
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1. "Three HAL fans will try meth"
    a. Threonine = Three 
    b. Histidine; Arginine; Lysine = HAL
    c. Phenylalanine = fans
    d. Valine; Isoleucine; Leucine = will
    e. Tryptophan = try
    f. Methionine = meth
... usmleuser007 made a comment on nbme21/block1/q#17 (A 7-year-old girl is brought to a clinic in a...)
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essential Amino acids (AA)

1) Adults require 9 (AA) = able to make argnine via urea cycle 2) Children require 10 (AA) = they are still developing 3) With PKU tyrosine becomes essential in both adults and children

... codyluvr95 made a comment on nbme21/block1/q#17 (A 7-year-old girl is brought to a clinic in a...)
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submitted by codyluvr95(3)

B12 comes from protein and is a necessary cofactor for methionine synthase. Low B12 = low methionine.

... mcl made a comment on nbme21/block1/q#19 (A 22-year-old man has had frequent episodes of...)
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Patient may have hereditary angioedema, which is associated with "recurrent attacks of intense, massive, localized subcutaneous edema involving the extremities, genitalia, face, or trunk, or submucosal edema of upper airway or bowels". The article goes on to say "C1-esterase inhibitor works directly on the complement and contact plasma cascades to reduce bradykinin release" which is also probably good to know.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3666183/

notadoctor  Thought this was a trick question as C1 esterase deficiency also results in a decrease in C4. However, the second answer choice was not referring to C4 but to C4 binding protein, which I now know is different. I also didn't realize C1 esterase was technically a complement protein.
... est88 made a comment on nbme21/block1/q#20 (A 10-year-old girl develops fever, malaise, and loss...)
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Rabies Virus (rhabdoviridae)

Fever, encephalitis, drooling

... haliburton made a comment on nbme21/block1/q#20 (A 10-year-old girl develops fever, malaise, and loss...)
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Rabies attacks the nicotinic Acetylcholine receptor, and travels retrograde via dynein motors after binding AChR, according to FA.

... uslme123 made a comment on nbme21/block1/q#20 (A 10-year-old girl develops fever, malaise, and loss...)
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very stupid question. The virus was inhaled -- bats hang upside when they sleep and drool. So it spreads to the brain directly from the olfactory system via retrograde transport through nerves.

... hayayah made a comment on nbme21/block1/q#22 (A 36-year-old man with AIDS elects to participate in...)
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submitted by hayayah(229)

Cysteine-cysteine chemokine receptor 5 (CCR5) is a protein found on the surface of CD4 cells.

yotsubato  Note, this is NOT in FA
... thechurchofbobbyhill made a comment on nbme21/block1/q#23 (A 59-year-old man comes to the physician because of...)
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Hi- I don't have an explanation for this but I am also curious as to why this was the answer.

drdoom  via @hyoscyamine: FA pg.372. Squamous cell carcinoma occurs in the upper 2/3 of esophagus whereas adenocarcinoma occurs in the distal 1/3. Since this was in the mid esophagus, its squamous cell carcinoma. Key feature of squamous cell carcinoma is keratin pearls.
... est88 made a comment on nbme21/block1/q#23 (A 59-year-old man comes to the physician because of...)
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I believe its Squamous cell carcinoma. Its centrally located, smoker, and its a hilar mass. Keratin pearls.

... hyoscyamine made a comment on nbme21/block1/q#23 (A 59-year-old man comes to the physician because of...)
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FA pg.372. Squamous cell carcinoma occurs in the upper 2/3 of esophagus whereas adenocarcinoma occurs in the distal 1/3. Since this was in the mid esophagus, its squamous cell carcinoma. Key feature of squamous cell carcinoma is keratin pearls.

... meningitis made a comment on nbme21/block1/q#23 (A 59-year-old man comes to the physician because of...)
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Squamous and Small cell carcinomas are Sentral (central) and often caused by Smoking

Hilar mass C arising from bronchus; Cavitation; Cigarettes; hyperCalcemia (produces PTHrP). Keratin pearls D and intercellular bridges.

pg 669 2019 FA

... vonhippelindau made a comment on nbme21/block1/q#24 (A 23-year-old man drinks alcohol heavily on a...)
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It’s acute alcohol consumption so fatty change more likely. Cellular swelling indicates alcoholic hepatitis which requires chronic alcohol consumption (See FA 2019 pg 385). At least that’s the logic I used to pick fatty change.

seagull  Seems like fatty change would require more than 1 weekend. I choose swelling since it's reversible and seems like something with a quick onset.
nc1992  I think it's just a bad question. It should be "on weekends"
uslme123  https://webpath.med.utah.edu/LIVEHTML/LIVER145.html
uslme123  So his hepatocytes aren't dying ( ballon degeneration ) vs just damaged/increased FA synthesis due to increased NADH/citrate
sympathetikey  @seagull I agree!
... sweetmed made a comment on nbme21/block1/q#24 (A 23-year-old man drinks alcohol heavily on a...)
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Fatty Change in Liver [2/2 High NADH made by ADH and AldDH -> inhibits FA oxidation, impaired lipoprotein assembly and secretion-> FA accumulates.]

... usmleuser007 made a comment on nbme21/block1/q#24 (A 23-year-old man drinks alcohol heavily on a...)
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As per FA 1) fatty infiltration 2) cellular ballooning 3) eventual necrosis

... neonem made a comment on nbme21/block1/q#25 (A 28-year-old man is brought to the emergency...)
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submitted by neonem(94)

Major risk factor for aortic dissection is hypertension, and in this case might be due to cocaine use, which causes marked hypertension. Dissections cause a tear in the tunica intima -- blood can flow backwards into the pericardium and cause tamponade. This manifests as crackles in the lung due to poor left ventricular function (filling/diastolic problem due to compression).

... sympathetikey made a comment on nbme21/block1/q#26 (A 62-year-old man who is a farmer comes to the...)
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submitted by sympathetikey(102)

The whole "picks at the lesion...causes some bleeding", made me think Psoriasis. Should have gone with Actinic Keratosis based on the patient history (lots of sun exposure).

Actinic Keratosis

Premalignant lesions caused by sun exposure. Small, rough, erythematous or brownish papules or plaques. Risk of squamous cell carcinoma is proportional to degree of epithelial dysplasia.

... benzjonez made a comment on nbme21/block1/q#27 (A 60-year-old man is brought to the emergency...)
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submitted by benzjonez(5)

FA 2018 p. 609. Suspect urethral injury if blood is seen at the urethral meatus. Mechanism of posterior urethral injury = pelvic fracture, which we see in this patient. Urethral catheterization is relatively contraindicated.

... hayayah made a comment on nbme21/block1/q#28 (A 47-year-old man is brought to the emergency...)
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Mixed venous oxygen saturation (SvO2) is measured in the pulmonary artery. SvO2 samples the true mixed venous blood leaving the right heart. Measurement of mixed venous oxygen saturation (SvO2) from the pulmonary artery has been advocated as an indirect index of tissue oxygenation.

In cardiogenic shock you have decreased CO --> decreased O2 delivery --> decreased SvO2.

... nicnac20 made a comment on nbme21/block1/q#28 (A 47-year-old man is brought to the emergency...)
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Mixed venous oxygen tension is the amount of oxygen bound to hemoglobin as it returns to the right side of the heart after traveling to the tissues.

Decreased oxygen delivery to the tissues due to decreased cardiac output leads to the tissues extracting more oxygen from the passing RBCs than they normally would, which decreases the overall mixed venous oxygen tension.

... mcl made a comment on nbme21/block1/q#30 (A newborn has female external genitalia and a 46,XY...)
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Per p608 in FA 2019, SRY on Y chromosome results in development of testes. DHT results in development of male external genitalia (and the prostate).

mrsmac  No sertoli cells or lack of mullerian inhibitory factor makes more sense. bc there is both male and female internal genitalia but only male external genatalia. and karyotype would show 46XY. First Aid 2018 pg. 604 - the "Sexual Differentiation" charge delineates exactly this. If it were 5areductase deficiency the child would have testicles and scrotum, which in this case is absence. Hope this makes sense. Please let me know if you disagree and why. Thanks.
mixmasta  I believe the tricky part is that they don't mention the status of the Male external genitalia. Pg. 605 from FA ( bottom portion) shows the external development of the Male/Female genitalia; you see DHT is need for male. Furthermore, pg. 604 (SEXUAL DIFFERENTIATION) DHT is also needed for Male external development.
... yo made a comment on nbme21/block1/q#30 (A newborn has female external genitalia and a 46,XY...)
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Dang this question threw me off because it said female genitalia when I thought it would be ambiguous at birth. DHT still makes the most sense. Thanks.

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